Proseal喉罩并全静脉麻醉在老年人手术中的应用

Application of proseal laryngeal mask combined with total intravenous anesthesia in surgery for elder patients

目的评价Proseal喉罩并全静脉麻醉用于老年患者手术时的安全性及有效性。方法选择ASAⅠ～Ⅱ级、年龄≥60岁择期手术老年患者60例,随机分为两组,每组30例。记录两组患者插管(罩)前(T1)、插管(罩)即刻(T2)、插管(罩)后3min(T3)、停药即刻(T4)、拔管(罩)即刻(T5)、拔管(罩)后3min(T6)的平均动脉压和心率变化。记录两组患者插(拔)管时呛咳反应及术后不良反应的发生情况。结果喉罩组插(拔)罩前后的HR、MAP无明显变化,气管插管组拔管即刻HR、BP显著高于拔管前(P<0.05);气管插管组呛咳反应、咽痛、声嘶、恶心呕吐发生率明显高于喉罩组(P<0.01)。结论 Proseal喉罩并全静脉麻醉具有置入方便、围麻醉期循环稳定、不良反应少的优点,用于老年患者手术较气管插管全麻更安全舒适。

Objective To evaluate the safety and effectiveness of proseal laryngeal mask combined with total intravenous anesthesia in the surgery for elder patients.Methods Sixty elder patients with ASA grade Ⅰ-Ⅱ and age ≥ 60 years,were randomly divided into two groups,with 30 patients in each group respectively.The mean artery pressure（MAP）and heart rate（HR）changes before intubation（mask insetion）（T1）,at immediate intubation（mask insetion）（T2）,3 minutes after intubation（mask insetion）（T3）,at immediate drug withdrawal（T4）,at immediate extubation（mask removal）（T5） and 3 minutes after extubation（mask removal）（T6）of both groups were recorded.The occurrence of choking cough response and postoperative adverse reactions at intubation（extubation）of both groups was recorded.Results In the laryngeal mask group,HR and MAP did not change significantly before and after mask insertion（removal）,but in the tracheal intubation group,HR and BP at immediate extubation were significantly higher than those before extubation（P0.05）.The incidence rates of choking cough reaction,pharyngalgia,hoarseness,nausea and vomiting of the tracheal intubation group were significantly higher than those of the laryngeal mask group（P0.01）.Conclusion Proseal laryngeal mask combined with total intravenous anesthesia has the advantages of convenient placement,stable circulation in perianaesthetic stage and few adverse reactions,thereby more suitable for the surgery for elder patients than general anesthesia by tracheal intubation.